California Department of Public Health Joins the Fight Against Devastating Wildfires

July 05, 2018|12:46 p.m.| ASTHO Staff

Last year’s wildfires in California caused historic levels of damage and destruction. Fires erupted as far north as the Klamath National Forest along the California-Oregon border and as far south as San Diego. Some blazes engulfed areas surrounding major cities including Los Angeles, Santa Barbara, Santa Rosa, and Ventura, burning through mountainsides and neighborhoods. More than 9,000 wildfires roared through California, burning 1.2 million acres of land—an area the size of Delaware—destroying more than 10,800 structures, and causing at least 46 deaths. The Thomas Fire, first reported on December 4, 2017, scorched nearly 300,000 acres across southern California, making it the largest fire ever recorded in California history.

To reflect on last year’s particularly devastating wildfire season, ASTHO spoke with Karen Smith, director and state health officer of the California Department of Public Health (CDPH), about the firefighters and law enforcement personnel who worked day and night in nightmarish conditions to keep communities safe, the department’s incredible work reaching out to affected healthcare facilities, ensuring patient safety, assisting at medical shelters, and facilitating and monitoring repopulation of displaced patients, as well as steps California is taking to ensure increased preparedness and safety for the 2018 wildfire season.

How has CDPH partnered with local health departments (LHDs) to respond to last year’s devastating wildfire season?

CDPH has a long history of partnering with LHDs. Last year’s fires were unprecedented and in some ways our response was as well. Many CDPH programs and staff were directly engaged in the disasters, and it is impossible to overstate their contributions. These dedicated people—some whose homes were destroyed—worked around the clock for weeks.

CDPH’s efforts were spearheaded by our Emergency Preparedness Office through the activation of the Medical and Health Coordination Center (MHCC), which serves as the primary link to LHDs and other state and federal partners during emergencies. One of MHCC’s key accomplishments was the use of ArcGIS, a geographic information system, to map facilities impacted by fires. A dashboard and map that incorporated data from multiple departments was created to share with LHDs, as well as state and federal partners, to reflect the status of healthcare facilities. We had three primary objectives: (1) provide real-time situational awareness across departments, (2) ensure that individuals in impacted regions had access to medical services, and (3) ensure that those who use or reside in community care facilities had access to those services and facilities.

In addition, the fires generated a large amount of smoke that spread into other counties causing unhealthy air quality that persisted for days. CDPH received numerous questions from LHDs about whether respiratory protection could, or should, be used to protect the public and employees who work outdoors from exposure to smoke particles. Additional questions included how people could safely return to their homes without disturbing the ash and risking additional health problems. The smoke and ash from these fires also exposed the population to inhalation of particulate matter. Many LHDs requested easy-to-read guides for residents who would be returning home to fire-damaged areas.

There are many other facets I could mention—and many people to thank. Our Center for Health Care Quality operates our Licensing and Certification Branch. Almost immediately after the fires began, licensing and certification staff teamed up to get a census of healthcare facilities in the area. Our Center for Environmental Health participated in a multi-agency debris management group and provided support to local environmental health departments on recovery operations and mutual aid arrangements. Our Center for Family Health, responsible for our Women and Infant Children (WIC) program, encouraged local agency WIC staff to transfer participants affected by wildfires and provided guidance on reissuing WIC checks lost due to the fires. Our Center for Family Health, which also runs our Genetic Screening Program, helped facilities ensure that all babies received newborn screening tests and that nothing was overlooked in the chaos caused by the fires. In addition, our Center for Health Statistics and Informatics played a crucial role in supporting LHDs and state governmental response to California wildfire victims.

In what ways did the California Department of Public Health collaborate with other state entities (e.g., law enforcement, fire fighters, the healthcare community, and medical shelters) to bolster response and recovery efforts?

CDPH, along with our sister departments in the California Health and Human Services Agency (CHHS), found numerous ways to collaborate with other state entities during the 2017 wildfire season. New relationships were forged and creative solutions were found by partnering in new and uncommon ways. For example, one of the entities impacted during the fires in Sonoma County was the Sonoma Developmental Center, a state-owned and operated facility. It became necessary to evacuate over 250 developmentally disabled adults and staff—not once, but twice. Their second placement was at a fairgrounds many miles away from the fire. The fairgrounds facility was transformed into an environment safe for these patients. Through joint efforts with the Emergency Medical Services Authority, the California National Guard, and the California Conservation Corps, mobile medical tents were erected and made available to serve as staff sleeping and eating areas. CalFire, the state agency responsible for fire protection, provided staffing for an emergency operations center. When it came time to prepare the Sonoma Developmental Center so that patients could be repatriated, the California National Guard sent over 100 personnel to clean and ready the facility.

This is just one example. Again, there is so much more. My executive staff, staff at the centers and programs, as well as our Office of Legal Services (OLS) worked with CHHS, the governor’s office, the California Office of Emergency Services, and other entities on a number of initiatives addressing the challenges presented by the fires. This included drafting language for inclusion in Executive Orders issued by Gov. Brown that expedited the removal, storage, transportation, and disposal of hazardous and non-hazardous debris resulting from the fires. OLS also worked with staff and executives to draft language for inclusion in an Executive Order issued by Gov. Brown designed to expedite recovery efforts of healthcare facilities in impacted communities.

What is California doing now, in the aftermath of last year’s wildfire season, to ensure increased public health preparedness for the future?

State and local public health has learned so many valuable lessons from the 2017 wildfires, including:

Mass sheltering and the challenges this presents, such as movement and distribution of pharmaceutical supplies, medical care, and disease control.

Air quality and ash issues

Debris clean-up and soil remediation

Facility and property repopulation

One of our primary goals now is to share lessons learned using every available avenue. We are in the process of creating a fire guidance document for our local health officers on a broad range of topics they are likely to face during a catastrophic fire. In addition, CDPH, our sister departments, and LHDs are sharing our experiences and lessons learned at conferences, meetings, and in publications like this one to help others learn from our experiences.

Reflecting on last year’s wildfire season, what advice do you have for public health officials who may be called on to respond to similar emergencies?

Be prepared, but know that every emergency is different. Know your partners and if they are joint decisionmakers. Understand which decisions are yours alone and which you must make with others. Be flexible, nimble, and ready for the unexpected. Lastly, invest in training your staff. They are absolutely critical to your response efforts.